Too Many Unnecessary MRIs and CT Scans?

A user guide to health care reform

In our healt hcare system, scanning has become a prime example of technology's unintended consequences.

Molly Birnbaum was in a car accident that left her with multiple injuries. She fractured her pelvis, and hurt her knee.

"I broke the windshield with the back of my skull," she said.

She was given a total of nine CT scans during her week-long hospital stay. Doctors wanted even more, but her father, resisted. And he's a radiologist.

"At that point, I drew a line in the sand and said, absolutely not. There is no reason to do this anymore," said Dr. Steve Birnbaum.

CT scans use radiation similar to x-rays. MRI's use magnetic fields. Doctors order one or the other depending on what they're looking for. Both have revolutionized medical diagnosis.

Health Care Special Report
American College of Radiology
More about CT Scans
More about MRIs

The problem is a growing number of critics say tests like these are overused.

"We're definitely doing too many procedures," said Dr. Howard Forman, Professor of Radiology at Yale School of Medicine. "Every time we work in the ER or in the in-patient setting, after the fact, it becomes very obvious that certain studies either could've been avoided, delayed or not done at all."

Now there's also widespread concern over skyrocketing costs.

CT scans are big money makers, costing anywhere from $300 to $1,000. MRIs run as high as $1300.

The annual price tag for imaging? $100 billon. And experts estimate 35 percent of these tests aren't even necessary. That's potentially $35 billion wasted every year.

Forman says faster machines are helping to drive demand. "Fifteen years ago, the CT scanner would scan at a rate that could maybe get 3 or 4 patients through in a given hour. Now if you have able-bodied people moving the patient on and off the table, you could probably do a dozen or more patients in an hour."

In fact, from 2000 to 2007 the annual number of CT scans almost doubled to 69 million.

"It's too easy, too fast, too good. So it's much easier to order the test than it is to observe the patient, to monitor the patient," said Dr. Steve Birnbaum, "and avoid doing the CT scan."

Then there is the potential harm to patient safety. Experts are concerned that tests like CT scans - which use radiation - might increase the risk of cancer.

So how do you fix the overuse of CT scans and other high tech procedures?

The bills before Congress aim to reduce Medicare payment rates for scanning, increase funding for studies comparing different treatments to see what works best, and encourage conversion to electronic medical records. So tests aren't mistakenly duplicated and doctors have a database of results to learn from.

But some people aren't waiting for Washington's version of reform. Motivated by his daughter's experience, Dr. Birnbaum started a program flagging doctors if a patient seems to be receiving too many tests.

I'm very pleased with the results. I feel like I've done something in the fall of my career to really help patients," Dr. Birnbaum said.

Patients have to take responsibility, too. So often they demand instant answers and high tech tests.

But giving patients what they want is not necessarily what's best for them. Doctors need to spend time doing a careful history and physical before you can reassure somebody that their pain could be from something innocent. It's a lot quicker and easier to order a scan.

  • Jon Lapook
    Jonathan LaPook

    Dr. Jonathan LaPook is the chief medical correspondent for the CBS Evening News. Follow him on Twitter at @DrLaPook